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New Technologies for Craniofacial Surgery at Faces+

New technologies and techniques that may be beneficial to your child include: Neonatal Cleft Lip Repair, Neonatal Mandibular Distraction, Mandibular Distraction, Midface Distraction, Bioresorbable Devices, Endoscopic Craniofacial Surgery.

Contents

About Neonatal Cleft Lip Repair Neonatal Mandibular Distraction Mandibular Distraction Midface Distraction Bioresorbable Devices Endoscopic Craniofacial Surgery

About

The Surgeons at FACES+ are recognized for their development of New Technologies and implementation of new techniques for use in the field of craniofacial surgery. New technologies and techniques that may be beneficial to your child include:

Neonatal Cleft Lip Repair

Neonatal Cleft Lip Repair is performed by the experienced FACESplus pediatric craniofacial plastic surgeons at the Children’s Hospital of San Diego. In July of 2000 the FACESplus surgeons, working with the Medical Director of Children’s Hospital Craniofacial Center, embarked on a new program of neonatal cleft lip repair. Children seen with a prenatal diagnosis confirmed by ultrasound are prepared for neonatal cleft lip repair even during pregnancy. Neonatal cleft lip repair means repairing the lip shortly after birth and, at times, even before the mother goes home from the hospital.

The neonatal treatment of cleft lips requires the coordination of a craniofacial team and a hospital specialized in the surgery and recovery of newborns. Neonatal cleft lip repair eliminates the usual three-month waiting period, assists with maternal-child bonding, relieves parental anxiety, and improves feeding right from the start of the new baby’s life. Providing the child has no other associated medical conditions and is judged to be a good candidate to undergo general anesthesia, neonatal cleft lip repair is now available at Children’s Hospital of San Diego through the craniofacial surgical services.

Neonatal Mandibular Distraction

Neonatal Mandibular Distraction is performed when a small jaw lets the tongue fall back and obstruct the airway. By lengthening the mandible the tongue is brought forward to open the airway, and a tracheostomy (opening into the windpipe) can be avoided.

Airway management in the newborn requires teamwork by pediatric craniofacial surgeons, pediatric ear-nose-throat surgeons, pediatric anesthesiologists, and the staff of a neonatal intensive care unit.

The technique of neonatal mandibular distraction involves placing small pins in the back of the lower jaw and then making a bony cut (osteotomy) between the pins. The pins are then gradually moved apart, usually 2 mm per day, to lengthen the mandible. New bone regenerates and fills in the gap. After the new bone has a chance to harden, the pins are then removed from the mandible.

Neonatal mandibular distraction has been used to lengthen the jaw as much as 2.5 cm, and has been highly successful in avoiding a tracheostomy in the neck. Distraction is also routinely utilized in older children. The craniofacial surgical service at Children’s Hospital of San Diego is experienced with the technology and techniques involved and, to our knowledge, is the only center in California offering this type of newborn distraction treatment.

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Mandibular Distraction

Mandibular Distraction is a technique where the lower jaw is cut after pins are placed in the bone on either side. Once the cut (osteotomy) is made in the bone, the pins are gradually moved apart (distracted) and new bone formation occurs in the gap by a process called distraction osteogenesis. 

New technologies have resulted in multi-vector distractors that permit mandibular transport in all planes of space to yield a more optimal outcome. 

Distraction osteogenesis of the mandible has been used to correct asymmetric jaws in patients with hemifacial microsomia, to lengthen jaws in patients with obstructive sleep apnea and to correct recessed lower jaws at any age.

Children with permanent tracheostomies are sometimes good candidates for this technique of mandibular distraction. The technique is safe and simple, and the FACES+ craniofacial surgeons have been involved in popularizing the majority of techniques used for mandibular distraction in the major centers of this country.

Midface Distraction

Midface Distraction is a technique where the upper jaw, cheeks, nose and orbital rims are moved forward to correct their underdevelopment. When needed, the forehead can also be moved forward. Using a technique called facial bipartition a flatness of the face or forehead can also be corrected at the same time. Distraction of the midface has been made possible by utilizing internal devices as well as external devices for the gradual advancement of the face with new bone formation in the gaps. This technique, generically called distraction osteogenesis, is most beneficial in children with syndromic craniosynostoses such as Apert syndrome, Crouzon syndrome, and Pfeiffer syndrome.

Because of their extensive experience with the technologies and techniques of midface distraction, the FACES+ surgeons see children from throughout the world for treatment of these very complex problems. 

Other children who may benefit from midface distraction, include those with cleft lip and palate who have severely recessed upper jaws. The FACES+ pediatric craniofacial plastic surgeons have experience with most of the commercially available devices. In addition they have been developers of some of the more popular internal devices used throughout the world.

Dr. Steven R. Cohen developed one of the first internal metallic systems, the MID system carried by Stryker-Leibinger, Inc. Dr. Steven R. Cohen and Dr. Ralph E. Holmes also developed the first biodegradable distraction device, working closely with the development team at MacroPore, Inc. in San Diego.

Bioresorbable Devices

Bioresorbable Devices are now available for use in virtually all craniomaxillofacial and neurosurgical skeletal repairs and reconstructions. The ease with which these devices are contoured and fixated has led to newer and quicker techniques that improve a child’s appearance. After bone healing is completed, these devices dissolve in the body and leave no trace. Made out of polymers that are native to the body, these devices are free of harmful effects.

Dr. Ralph E. Holmes is one of the founders of MacroPore, Inc. in San Diego, a leading international bioresorbable device company. Together with Dr. Steven R. Cohen, these craniofacial surgeons have worked with MacroPore, Inc. to develop new devices such as biodegradable distraction plates. They also serve as a primary development site for newer techniques of utilizing bioresorbable devices, such as in complex otoplasty and rhinoplasty.

Cutting-edge technologies and changes in surgical techniques are being demonstrated to surgeons throughout the country and overseas by Dr. Steven Cohen and Dr. Ralph Holmes. They have traveled to centers such as Johns Hopkins, Stanford, New York University, and many other leading craniofacial centers to lecture as well as to demonstrate these techniques.

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Endoscopic Craniofacial Surgery

Endoscopic Craniofacial Surgery is a minimally invasive surgical technique that utilizes small skin incisions for access. When diagnosed early, children with premature fusion of the sutures of the skull are candidates for surgery using endoscopic technology and techniques. The conventional technique involves making two small incisions in the scalp and using an endoscopic assisted approach to remove the fused sutures of the skull. Correction of the head shape deformity is then carried out by fitting a band or helmet that the child must wear for up to eight months following surgery to achieve optimal results. 

At Children’s Hospital of San Diego, endoscopic craniofacial surgery is carried out with immediate reconstruction and band therapy is utilized in selected cases for only two to four weeks for final reshaping. 

The FACES+ pediatric craniofacial plastic surgeons have developed new techniques of endoscopic cranial reconstruction utilizing specially made biodegradable plates that permit immediate reconstruction of the cranial vault deformity, thus eliminating or shortening the length of postoperative band or helmet therapy.

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